The primary aim was to register the incidence of surgical wound infections (SWI) in sternotomy and leg incisions and potential risk factors for SWI following coronary artery by-pass graft (CAGB) procedures. Patients’ perspectives of SWI and the subsequent treatment were also considered. Risk factors were registered for 374 patients. Patients were contacted by telephone 30 and 60 days after surgery and interviewed according to a questionnaire about symptoms and signs of wound infections. SWI was defined according to The Centers for Disease Control. Patients with mediastinitis were also interviewed within four months about how they experienced care, how they coped and how they thought the mediastinitis would influence their future life. SWIs were diagnosed in 30 % of the patients. Seventy-three percent of the SWIs of the leg were diagnosed within 30 days of surgery and 27% were diagnosed within 31 to 60 days. Female gender and use of a monofilament suture for skin closure were the most important risk factors for SWI of the leg. Low preoperative haemoglobin concentration was the most important risk factor for sternal SWI. Patients with mediastinitis had higher BMI and had more often received erythrocyte transfusions on postoperative day 2 or later than those without infections. Patients without a diagnosis of diabetes who had increased blood glucose concentrations during the intermediate postoperative period had an increased risk of mediastinitis. It was not possible to separate the effect of diabetes as a risk factor for SWI from that of hyperglycaemia as such. Patients’ experiences were influenced by the staffs’ medical knowledge, how care was given and how well information was provided. Perceived danger and stress influenced how they coped with the situation. The patients believed that the mediastinitis would not affect the final outcome of the CABG procedure, even though their confidence in this was influenced by uncertainties about the rehabilitation process.

Bakgrund Diabetes typ II är ett globalt och nationellt växande hälsoproblem. Lågkolhydratkost har väckt debatt i samhället, men har enligt studier resulterat i gynnsamma effekter för patientgruppen. Socialstyrelsen rekommenderar måttlig lågkolhydratkost som en av flera primära alternativ till kosthållning för patienter med diabetes typ II. Syfte Att undersöka diabetessjuksköterskors attityd och kunskap gällande lågkolhydratkost vid diabetes typ II. Metod Kvalitativa semi-strukturerade intervjuer med sju diabetessjuksköterskor inom Uppsalas primärvård. Resultat Diabetessjuksköterskorna hade observerat positiva effekter i sitt kliniska arbete av kolhydratreduktion, men ingen sjuksköterska gav måttlig lågkolhydratkost som rekommendation i första hand till patienterna. Farhågor för att lågkolhydratkost, främst orsakat av ett ökat fettintag, skulle kunna resultera i en ökning av risken för hjärt-kärlsjukdom eller andra negativa hälsoeffekter skildrades. Medvetenheten gällande kostrekommendationer och uppdateringen kring aktuell forskning varierade. Slutsats Medvetenhet och kunskap gällande lågkolhydratkost som kosthållning vid diabetes typ II varierade hos diabetessjuksköterskor inom Uppsalas primärvård. Generellt kunde en negativ attityd till lågkolhydratkost urskiljas. För att upprätthålla en evidensbaserad hälso- och sjukvård är det av största vikt att diabetessjuksköterskor får möjlighet att inom arbetsplatsen hålla sig uppdaterade om aktuella forskningsresultat samt att skapa reflektion kring vilken extern och intern påverkan sjuksköterskor kan exponeras för. / Background Diabetes type II is an increasing problem on a national and global scale. Low carbohydrate diets have created debate in today society, all though it has come to show positive effects in studies made on this patient group. In the national guidelines by The National Board of Health and Welfare moderate low-carbohydrate diet is described as a primary diet recommendation for patients with diabetes type II. Aim To investigate the attitude and knowledge of nursing staff towards low-carbohydrate diets as a method for patients with diabetes type II to achieve positive health benefits. Method Qualitative semi-structured interviews with seven nurses in district health centers in Uppsala, Sweden. Result The nursing staff had observed health benefits as a result from low-carbohydrate diets in their daily clinical work with patient suffering from diabetes type II, yet none of the nurses did suggest patients to eat according to this diet. Apprehensions that low-carbohydrate diets, and specifically the increased intake of fat, would contribute to an increased risk of heart disease or cause other harmful bodily effects over a long period of time were described. The awareness of national guidelines and recommendation did vary widely among the nurses. Conclusion Awareness and knowledge regarding a low carbohydrate diet when it comes to patients with diabetes type II ranged with the diabetic nurses in Uppsala Primary Care. Generally, a negative attitude towards low carbohydrate diet could be distinguished. To maintain an evidence-based health care, it is important that diabetes nurses have the opportunity to be updated of current research and to make reflections on what kind of external and internal influences nurses may be exposed to.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

The rapid growth of biotechnology has promoted industries to harness the market in the field of human energy systems. A growing literature of research has linked human energy systems to weight loss, major diseases or illnesses. In our modern society, the general public is exposed to everyday stress, which often results in the development of chronic stress. Therefore, stress becomes an important area of medicine. It has been postulated that suppressing these physiological responses may help in disease prevention. Consequently, there is an urge for defining a model integrating stress with the human energy model. Over the past decades, a large amount of research has been put forward in defining the physiological responses or changes when an individual experiences psychological or environmental changes such as interpersonal dysfunction, traumatic experiences and diseases. Interestingly, it reveals that blood glucose fluctuation tends to be the end product of most psychological or physiological stressors. The blood glucose system is one of the major subsystems of the complete metabolic fuel system in humans. In this study, an empirical model and procedure for the derivation of the model due to various psychological influences on the human energy system are presented. This study can be divided into two main sections. An overview of a previously developed unit (ets: equivalent teaspoon sugar) for blood glucose quantification is given in the first section. Stress quantification methods are derived in the second section and a link between these methods and ets is drawn. A verification study of the derived model is also presented in the second section. Stress can be divided into physiological stress and psychological stress. Between the two types of stress, a generalised model based on studies of physiological stress has been drawn and accepted by the public. However, the generalised model does not account for psychological stress. Evidence shows that depending on the specific nature of a stressful circumstance, it can cause different activations of central circuits leading to the release of different neurotransmitters. However, these neurotransmitters have a common effect of increasing blood glucose concentrations. A substantial amount of literature shows that, when stress involves mental effort, epinephrine (EPI) is the main endocrine response. However, stress that does not require mental effort mainly induces cortisol release. The response models for different types of stress were derived using these relations. Furthermore, it is known that prolonged stress may lead to the development of disease. Several studies have used this observation and associated chronic stress with the relative risk factor of cardiovascular disease (CVD). Previously, different quartiles of risk factors for CVD have been related to blood glucose energy and ets expenditure. This link was further utilised to quantify chronic stress in this study. Increases in either of the two endocrine concentrations have been shown to raise the blood glucose level. In order to demonstrate the benefits of applying the ets concept, the cortisol and epinephrine responses were further quantified using the new glucose quantification method, the equivalent teaspoon sugar (ets) concept. The models derived in this study were verified against measured data. The models reveal a strong agreement with the measured data and therefore support the feasibility of these quantification methods. In conclusion, a link does exist between blood glucose energy and stress, and the highly accurate models derived for this association may serve as an adjunct tool for glycaemic control and stress management. / Thesis (Ph.D. (Electronical Engineering))--North-West University, Potchefstroom Campus, 2008.

Blood glucose management in Type 1 diabetes is crucial in preventing several diabetic complications. Blood glucose management is a complex task requiring diabetics too carefully administer the correct dosages of insulin by taking their blood glucose levels, food consumption, exercise, stress, illnesses and several other factors into account. Improved bolus calculation greatly aids in controlling blood glucose levels within a tight range. This study investigates how the ets-concept (Equivalent Teaspoons Sugar-concept) can be used to develop products to calculate insulin boluses. A cellular phone based software application was developed to calculate insulin boluses using the ets-concept. This product was tested in a clinical trial. A blood glucose characterization procedure was also developed to characterize the blood glucose response of a Type 1 diabetic to carbohydrate ingestion and insulin administration. The characterization procedure was used during the clinical trial to characterize patients in order to customize the bolus calculation products for the specific diabetic user. / Thesis (Ph.D. (Mechanical Engineering)--North-West University, Potchefstroom Campus, 2006

The correct administration of insulin is a constant challenge for type 1 diabetics. The correct insulin regime leads to fewer complications and an easier way of life. The amount of insulin administered must take into account the meals eaten, previous administered insulin, exercise etc. A rapid process for determining insulin regimes that is accessible to type 1 diabetics will greatly reduce diabetic complications later in life. This study researches such a process. Software is developed to use the ets-concept to simulate blood glucose levels. From these simulations blood glucose characterisation can be done to propose insulin regimes. Data gathered in previous studies is used to verify the results of this process. These results are compared to factors that describe the accuracy of a person's blood glucose control. The effects the new regimes will have are used to make recommendations to the end-user. Accurate characterisation leads to insulin regImes that will Improve the control performance of type 1 diabetes. / Thesis (M.Ing. (Electronical Engineering)--North-West University, Potchefstroom Campus, 2008.

The rapid growth of biotechnology has promoted industries to harness the market in the field of human energy systems. A growing literature of research has linked human energy systems to weight loss, major diseases or illnesses. In our modern society, the general public is exposed to everyday stress, which often results in the development of chronic stress. Therefore, stress becomes an important area of medicine. It has been postulated that suppressing these physiological responses may help in disease prevention. Consequently, there is an urge for defining a model integrating stress with the human energy model. Over the past decades, a large amount of research has been put forward in defining the physiological responses or changes when an individual experiences psychological or environmental changes such as interpersonal dysfunction, traumatic experiences and diseases. Interestingly, it reveals that blood glucose fluctuation tends to be the end product of most psychological or physiological stressors. The blood glucose system is one of the major subsystems of the complete metabolic fuel system in humans. In this study, an empirical model and procedure for the derivation of the model due to various psychological influences on the human energy system are presented. This study can be divided into two main sections. An overview of a previously developed unit (ets: equivalent teaspoon sugar) for blood glucose quantification is given in the first section. Stress quantification methods are derived in the second section and a link between these methods and ets is drawn. A verification study of the derived model is also presented in the second section. Stress can be divided into physiological stress and psychological stress. Between the two types of stress, a generalised model based on studies of physiological stress has been drawn and accepted by the public. However, the generalised model does not account for psychological stress. Evidence shows that depending on the specific nature of a stressful circumstance, it can cause different activations of central circuits leading to the release of different neurotransmitters. However, these neurotransmitters have a common effect of increasing blood glucose concentrations. A substantial amount of literature shows that, when stress involves mental effort, epinephrine (EPI) is the main endocrine response. However, stress that does not require mental effort mainly induces cortisol release. The response models for different types of stress were derived using these relations. Furthermore, it is known that prolonged stress may lead to the development of disease. Several studies have used this observation and associated chronic stress with the relative risk factor of cardiovascular disease (CVD). Previously, different quartiles of risk factors for CVD have been related to blood glucose energy and ets expenditure. This link was further utilised to quantify chronic stress in this study. Increases in either of the two endocrine concentrations have been shown to raise the blood glucose level. In order to demonstrate the benefits of applying the ets concept, the cortisol and epinephrine responses were further quantified using the new glucose quantification method, the equivalent teaspoon sugar (ets) concept. The models derived in this study were verified against measured data. The models reveal a strong agreement with the measured data and therefore support the feasibility of these quantification methods. In conclusion, a link does exist between blood glucose energy and stress, and the highly accurate models derived for this association may serve as an adjunct tool for glycaemic control and stress management. / Thesis (Ph.D. (Electronical Engineering))--North-West University, Potchefstroom Campus, 2008.

Blood glucose management in Type 1 diabetes is crucial in preventing several diabetic complications. Blood glucose management is a complex task requiring diabetics too carefully administer the correct dosages of insulin by taking their blood glucose levels, food consumption, exercise, stress, illnesses and several other factors into account. Improved bolus calculation greatly aids in controlling blood glucose levels within a tight range. This study investigates how the ets-concept (Equivalent Teaspoons Sugar-concept) can be used to develop products to calculate insulin boluses. A cellular phone based software application was developed to calculate insulin boluses using the ets-concept. This product was tested in a clinical trial. A blood glucose characterization procedure was also developed to characterize the blood glucose response of a Type 1 diabetic to carbohydrate ingestion and insulin administration. The characterization procedure was used during the clinical trial to characterize patients in order to customize the bolus calculation products for the specific diabetic user. / Thesis (Ph.D. (Mechanical Engineering)--North-West University, Potchefstroom Campus, 2006

The correct administration of insulin is a constant challenge for type 1 diabetics. The correct insulin regime leads to fewer complications and an easier way of life. The amount of insulin administered must take into account the meals eaten, previous administered insulin, exercise etc. A rapid process for determining insulin regimes that is accessible to type 1 diabetics will greatly reduce diabetic complications later in life. This study researches such a process. Software is developed to use the ets-concept to simulate blood glucose levels. From these simulations blood glucose characterisation can be done to propose insulin regimes. Data gathered in previous studies is used to verify the results of this process. These results are compared to factors that describe the accuracy of a person's blood glucose control. The effects the new regimes will have are used to make recommendations to the end-user. Accurate characterisation leads to insulin regImes that will Improve the control performance of type 1 diabetes. / Thesis (M.Ing. (Electronical Engineering)--North-West University, Potchefstroom Campus, 2008.

Diss. (sammanfattning) Uppsala : Univ., 2004. / Härtill 4 uppsatser.